36-Month Results From the Tack Optimized Balloon Angioplasty II Below-the-Knee Study

Purpose: The purpose of this study was analysis of clinical characteristics and results of surgical revascularization in patients with acute limb ischemia (ALI) and COVID-19, compared with cases without SARS-CoV-2 infection.

Materials and Methods: For 2 years (2020-2021), all consecutive patients with ALI admitted to the tertiary emergency vascular service and supposed to surgical revascularization were prospectively enrolled. On admission, all patients were tested for SARS-CoV-2 infection. The mortality, major amputation rate, and amputation-free survival (AFS) during 3 months’ follow-up were defined as study outcomes.

Results: One-hundred thirty patients (139 limbs with ALI) were included and 21 (16.1%) from them (23 limbs with ALI) were positive for SARS-CoV-2 infection. There was no significant difference in demographic and clinical characteristics of infected and noninfected patients. Lower limbs were affected more frequently: 90 (77.5%) limbs vs 17 (73.9%) limbs in the infected group. The ALI of Rutherford grade IIB was diagnosed mostly: 72 (62%) limbs in the noninfected group and 16 (69.5%) limbs in the COVID-19 patients. In 90% of cases, COVID-19 patients developed ALI during hospitalization. Thus, time from ALI onset until admission in vascular service and time from admission to revascularization both were insignificantly shorter compared with the noninfected group: 16 (6-24) vs 22 (5-96) hours and 2 (2-5) vs 3 (2-8) hours (P >.05). Infected patients had limited access to vascular imaging before revascularization. Computed tomography angiography was performed in 5 (21.7%) cases and duplex ultrasound in 2 (8.6%) cases, compared with 49 (42.2%) cases and 54 (46.5%) cases in the noninfected cohort (P <.05). Embolic etiology of ALI was diagnosed more frequently in the noninfected group: 86 (74.1%) vs 11 (47.8%) cases in patients with COVID-19 (P <.05). Patients with COVID-19 had significantly worse outcomes of treatment: 5 (21.7%) limbs were amputated and 9 (42.8%) patients died vs 12 (10.3%) limbs and 17 (15.5%) patients, respectively, in the noninfected group (P<.05 for mortality). At the end of follow-up, the AFS in the entire cohort was 69.2%: 74.3% in the noninfected patients and 42.8% in the COVID-19 group (P <.01).

Conclusions: Despite the similarity of clinic and demographic characteristics, patients with ALI and concomitant SARS-CoV-2 infection have significantly worse outcomes of surgical revascularization compared with noninfected cases.